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General NPI Number Information
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NPI Number | 1023685005
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Entity Type | Individual
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Provider Name | SERENA SPEARS COTA
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Gender | Female
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 4641 N 12TH ST STE 100
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City | PHOENIX
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State | AZ
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Zip | 85014-4085
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Country | US
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Telephone | 602-281-2896
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Fax |
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Provider Business Mailing Address
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Address Line | 12226 S PAIUTE ST
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City | PHOENIX
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State | AZ
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Zip | 85044-2122
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Country | US
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Telephone | 480-586-6590
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA-046929
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License Number State | AZ
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